Child Health/Ductus arteriosus agent

Ductus arteriosus drugs

also: alprostadil · prostaglandin E1 · dinoprostone · ibuprofen PDA · indometacin

Overview

The two OPPOSITE manoeuvres on the ductus arteriosus — one of the highest-yield neonatal pharmacology gates. Prostaglandin KEEPS the duct open; NSAID CLOSES it.

Mechanism

Prostaglandins (alprostadil = PGE₁, dinoprostone = PGE₂) maintain ductal patency — physiologically the duct is held open in utero by placental prostaglandins. Conversely ibuprofen/indometacin inhibit cyclo-oxygenase → ↓prostaglandin → promotes ductal closure (the mechanism by which the duct normally closes after birth as PG falls).

Indications

Prostaglandin: KEEP the duct open in duct-dependent congenital heart disease (until surgery)
NSAID: CLOSE a haemodynamically significant patent ductus arteriosus in a preterm infant

The agents

Alprostadil (PGE₁)KEEPS duct OPEN

IV infusion 0.01–0.1 mcg/kg/min

Duct-dependent lesions (e.g. TGA, coarctation, pulmonary/tricuspid atresia, HLHS) — buys time to surgery.

Ibuprofen / indometacinCLOSES duct

IV course

Symptomatic PDA in preterm; paracetamol an emerging alternative.

Adverse effects

Alprostadil: APNOEAserious

Classic — be ready to ventilate. Also fever, flushing, hypotension.

Ibuprofen/indometacin: renal impairment, oliguriaserious

Ibuprofen/indometacin: GI bleeding, necrotising enterocolitis, platelet dysfunctionserious

Cautions & contraindications

NSAID closure if duct-dependent circulationall

Closing a duct the systemic/pulmonary circulation relies on is fatal — the opposite of alprostadil.

NSAID closure with active bleeding, NEC, renal failure, thrombocytopeniaall

Interactions

Monitoring & kinetics

Alprostadil: apnoea/respiratory support, BP; Echo. NSAID: renal function, platelets, urine output

Alprostadil continuous IV infusion; NSAID a short IV course.

Source: BNF for Children — Alprostadil / ibuprofen (PDA)